Concussed Kids Need Break From School

ORLANDO -- Concussed kids should take time off from schoolwork, easing back into academics with the help of a recovery team, according to new pediatric guidelines presented here.

Children and adolescents who've suffered a concussion should receive help returning to academia in order to avoid making symptoms worse, and their recovery should be a team effort among healthcare professionals, school officials, and family members, according to Mark Halstead, MD, of Washington University School of Medicine in St. Louis, and colleagues.

"Unfortunately, because most children and adolescents look physically normal after a concussion, school ofﬁcials often fail to recognize the need for academic or environmental adjustments," the authors wrote in a clinical report in Pediatrics. "Cognitive difﬁculties, such as learning new tasks or remembering previously learned material may pose challenges in the classroom."

In addition, before returning to sports or other full physical activities, concussed kids should be able to perform at their "academic 'baseline,' " they said. The report was also presented at the American Academy of Pediatrics meeting.

One of the key features of the current guidelines is communication through the recovery team, noted Michael de Riesthal, PhD, of the Pi Beta Phi Rehabilitation Institute at the Vanderbilt Bill Wilkerson Center in Nashville, Tenn.

"Each team member needs to know what [his] role is and how to interact with other members of the team," de Riesthal told MedPage Today.

These teams should consist of a pediatrician or other healthcare provider to evaluate the concussion and prescribe appropriate treatment; the family to enforce rest and reduce stimulation during recovery; and two school teams -- one for physical activity and one for academics.

Early in injury, the school team should safeguard students from further injury and adjust academic stress to an appropriate level for the injured student. The injured student should be observed for which subjects exacerbate symptoms. Return to regular levels of mental, social, and physical activity should be gradual.

The authors noted that their current guidance "is based primarily on expert opinion and adapted from a program developed in Colorado to address the issue of 'return to learn.' "

They highlighted that the use of "cognitive rest," or restricting access to video games, texting, television, or schoolwork, could bring on additional stress and may be disruptive to recovery for a developing child or teen.

Adding such restrictions "calls for an individualized approach for the student when a pediatrician is making recommendations for cognitive rest and the student's [return to learn] in the school setting," they pointed out.

They warned that using a concussed brain to learn can have adverse effects on concussion symptoms or prolong recovery.

Healthcare professionals and academic staff, as well as extracurricular activity leaders, should recognize the signs and symptoms of a concussion, which include:

Headache

Dizziness and lightheadedness

Light sensitivity

Double or blurred vision

Noise sensitivity

Difficulty concentrating or remembering

Sleep disturbances

A symptom checklist can help determine severity of the injury as well as progress during recovery, they noted.

The multidisciplinary recovery team "should be well-versed in their roles and responsibilities in concussion management and keep communication among all parties regarding the decisions to progress, regress, or hold steady during the return to learn process," they noted.

The authors cautioned that if a student's symptoms last for longer than 3 weeks, additional medical management may be needed, and that further changes in academic and sports activity may not help. In such cases, students should be referred to concussion specialists if one is not already working with the injured party. Also, practitioners should be aware of local laws that may affect how flexible and creative treatments can be.

They concluded that future research is needed to clarify best practices for return to learning and the healing process in an academic environment. Research also is need to determine if cognitive rest is a useful intervention. Finally, studies are needed to compare outcomes of concussion management teams from different school settings versus outcomes in settings without such teams.

Aside from more research, de Riesthal called for more education for "the population of those who may experience concussion, medical providers, school support staff, and others who handle children who may experience concussion."

The authors have ﬁled conﬂict of interest statements with the AAP and any conﬂicts have been resolved by its board of directors.

All AAP clinical reports expire 5 years after publication unless reafﬁrmed, revised, or retired at or before that time.

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